HomeMy WebLinkAboutBLD2022-00736 - BLD Application - 6/8/2022 �$3, �1,)V'`'"j?i-t:.,1 MASON COUNTY COMMUNITY SERVICES Permit No: �) LI Z�-'l( p+-S E
t ,� PERMIT ASSISTANCE CENTER:
1.• z •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
L 71 I- '0 615 W.Alder Street,Shelton,WA 98584 J U N 0 8 2022
s Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
'12.4,-- a Belfair.(360)275 W67•Phone Elma:(360)482-5269
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�15 W. Alder Street
�- BUILDING PERMIT APPLICATION
W =PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
,C f"" NAME:Z4 e l'" SJ/2evv. D-6y NAME: De/r.4 yS 44.C
Z `"' MAILING ADDRESS:: 33 O tf, ' A:T/N eve MAILING ADDRESS: 3. / 4e?CjIit 41/t. s
CITY: $ *t/tt i STATE: Le`4 ZIP:T CITY:O//rn 7j4 STATE:4r4 ZIP:9852t/
,yO.• W PHONE#1: 3bO'(;2!-/`712 y PHONE: 366-731•7Ztf'CELL:
PHONE#2:360-41E,3- y/ EMAIL:&.4I2+>/-Dc 7i4-y Cd'C=.44A i i-
EMAIL: L&I REG#4E"i ft4 L*9 73(3 r EXP. 3 /'/2 3
Z PRIMARY CONTACT: OWNER 0 CONTRACTOR Ct OTHER
W NAME G•�fZ i�E7 ?41 EMAIL 6--")/�• b6T2L-Ay L G<+ .4 L
MAILING ADDRESS / 54--)r7 CITY STATE / ZIP
PHONE CELL 34,e,— Z 3 c% - 7 2 C'5--
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 6-2%C.)}7C -9 0 0/2 ZONING
LEGAL DESCRIPTTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS O O wr• lIAAiA-s' i,-k i Re/7 CITY SW GJ[-72i/l.,
DI CTIONS TO SITE ADDRESS SE2/7401"A1!47/t c Pew 'it, t>tJ' HAA4K1 LK' ..•/, i 2
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO[:]SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 113/ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER Ey A hii
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) /CC L S/ i.Air G-£
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS / NUMBER OF BATHROOMS /
HEATED STRUCTURE? YES(Whole Bldg)EY YES(Part[s]ofBldg)0 NO❑
DESCRIBE WORK //lt.Sr4/I fl CI) 6;11.3/'1"E 4"N(
SQUARE FOOTAGE:(proposed)p
1ST FLOOR /72 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED�jJ ,t�H�OME INFORMATIOON: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE 5/Ky/i'V e-_•_ MODEL. ,52.00 6 T5 YEAR.0 Z, LENGTH 3-6
WIDTH r .... BEDROOMS / BATHS / SERIAL NUMBER 07 7'S
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC[[9 SEWER 0 / NEW[ EXISTING 0
PLUMBING IN STRUCTURE? YES re NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO( EXISTING SQ.FT.
EXISTING BEDROOMS S PROPOSED BEDROOMS 1 TOTAL BEDROOMS y
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICAT OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) _
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Signatur f OW •
NER ust be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS •
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL j� �
PUBLIC HEALTH P-er (ii bZZ Cc 4740%-S a_U2o
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EH APPROVED t
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Rhonda Thompson 06/23/2022 •
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EH Setbacks fOO.2te,/" ;
A.) Drainfield/Reserve requires 10'setback from footing/foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reserve area `
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